Elongate flexible torque instruments and methods of use

ABSTRACT

Torque shafts and other related systems and methods are described herein. In one embodiment, the torque shafts are both flexible and capable of transmitting torque. An apparatus for transmission of torque includes an elongate body, comprising a plurality of joint segments, each joint segment configured to pivot with respect to an adjacent segment and being further configured to have at least two link elements.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. Non-provisional applicationSer. No. 12/242,196, filed Sep. 30, 2008, which is acontinuation-in-part of International Application No. PCT/US2007/071535,filed Jun. 19, 2007, which claims priority to U.S. ProvisionalApplication No. 60/805,334, filed Jun. 20, 2006, each of which isincorporated herein by reference in its entirety for all purposes.

BACKGROUND OF THE INVENTION Field

Embodiments of the present invention relate generally to elongateflexible instruments, and more particularly, to the manufacture and useof such elongate flexible instruments, which may be configured to beextension tools for a variety deployment, placement, installation,maintenance, repair, or removal type of functions, procedures,operations, or applications.

BACKGROUND

Typical elongate flexible instruments may be comprised of flexibleshafts, tubes, rods, etc., which may be susceptible to torque deflectionor torque lag to the extent that rotation of one end of the instrumentmay not correlate closely to rotation of the opposite end of theinstrument and substantial amount of wind-up or excessive amount ofinitial rotation or torque may be required at the outset beforecorrelatable rotation or torque transmission could be achieved. Inaddition, elongate flexible instruments may be susceptible to bucklingand/or kinking such that reliable torque transmission may be forpractical purposes virtually impossible. Accordingly, there is a needfor an elongate flexible instrument that allows improved transmission ofrotation or torque.

BRIEF SUMMARY OF THE INVENTION

Various embodiments of an apparatus for transmission of torque aredisclosed herein. In one variation, an apparatus for transmission oftorque includes an elongate body, wherein said elongate body iscomprised of a plurality of segments; each segment may be configured toflex or pivot with respect to an adjacent segment and each segment mayinclude at least two link elements.

In one example, an apparatus for transmitting torque includes aplurality of joined segments in an axial arrangement, wherein each ofsaid segments may be linked or joined to an adjacent segment by a livinglink element and the segments may be configured to flex or pivot aboutsaid living link element.

In another example, an apparatus for transmitting torque includes anelongate body, wherein said elongate body may be comprised of aplurality of joined segments. Each segment may be configured to flex orpivot with respect to an adjacent segment and each segment may beconfigured to have a pair of link elements. Each link element mayinclude a hub and a plurality of living link elements extending fromsaid hub that may be coupled to a rim of an adjacent segment.

An exemplary embodiment of a method for operating an apparatus fortransmitting torque is disclosed, which may be applicable to any or allof the apparatuses as described in accordance with embodiments of thepresent invention disclosed herein. The method may include attaching amedical prosthesis at a distal end of said torque transmittingapparatus, inserting said prosthesis into a patient's vasculature,navigating within said patient's vasculature, and deploying said medicalprosthesis at a target region.

Other systems, methods, features, and advantages of the presentinvention will be apparent to one of ordinary skill in the art uponexamination of the following figures and detailed description. It isintended that all such additional systems, methods, features, andadvantages be within the scope of the present invention. It is alsointended that the present invention is not limited to the specificdetails of the exemplary embodiments.

BRIEF DESCRIPTION OF THE DRAWINGS

The details of the invention, both as to its structure and operation,may be gleaned in part by study of the accompanying figures, in whichlike reference numerals refer to like parts. The components in thefigures are not necessarily drawn to scale; instead emphasis is placedupon illustrating the principles of the invention. Moreover, allillustrations are intended to convey concepts, where relative sizes,shapes and other detailed attributes may be illustrated schematicallyrather than literally or precisely.

FIG. 1 illustrates an elongate flexible torque instrument in accordancewith one embodiment of the present invention.

FIG. 2A illustrates a portion of a flexible torque member in accordancewith one embodiment of the present invention.

FIG. 2B illustrates a portion of a flexible torque member in accordancewith one embodiment of the present invention.

FIG. 3 illustrates a portion of another flexible torque member inaccordance with one embodiment of the present invention.

FIG. 4 illustrates the interface of physical link element or splink linkelement and torque link element or torque finger element for oneexemplary embodiment of torque shaft (400) in a planar depiction.

FIG. 5 depicts a torque shaft with splink link and torque fingerinterlocking elements according to another embodiment.

FIG. 6A illustrates a side view of a torque shaft with a wagon wheellink element according to another embodiment of the present invention.

FIG. 6B illustrates an isometric view of the same torque shaft.

FIG. 7 illustrates one example of an interface or implementation offlexible torque members with an implant deployment apparatus inaccordance with one embodiment of the present invention.

FIGS. 8A-8C show a torque shaft with T-shaped interlocking featuresaccording to an embodiment.

FIGS. 9A-9B show a torque shaft with teardrop shaped interlockingfeatures according to another embodiment.

FIG. 10 illustrates the torque transferring capability of the torqueshaft.

FIG. 11 shows a torque shaft with spiral slots running the length of thetorque shaft.

FIGS. 12-13 show a spot-link torque shaft according to anotherembodiment.

FIG. 14 shows a torque shaft with living hinges according to anotherembodiment.

FIGS. 15-16 show two opposing torque shafts according to anotherembodiment.

FIG. 17 shows a pull-pull torque drive according to another embodiment.

FIG. 18 shows a device for translating axial force applied to the shaftinto rotational movement of the shaft.

FIG. 19A illustrates an example of an elongate flexible torqueinstrument being used to deliver an implant to a target site inside apatient in accordance with one embodiment of the present invention.

FIG. 19B illustrates an example elongate flexible torque instrumentbeing used in an antegrade approach to deliver an implant to a targetsite inside a patient.

FIG. 19C illustrates a process flowchart for using the elongate flexibletorque instrument to deliver and deploy an implant in accordance withone embodiment of the present invention.

FIG. 19D illustrates an example elongate flexible torque instrumentbeing used in a retrograde approach to deliver an implant to a targetsite inside a patient.

DETAILED DESCRIPTION

Elongate flexible torque instruments and methods for their use andmanufacture are described herein. The elongate flexible torqueinstruments in accordance with embodiments of the present invention maybe both flexible and stiff at the same time. In one embodiment, theelongate flexible torque instruments according to the present inventionare designed and manufactured to be substantially flexible for pivoting,steering, bending, etc., but substantially stiff in resisting rotationand axial compression or extension such that they may effectivelytransmit rotation or torque and axial forces, loads, movements, etc.,while it may be pushed, pulled, advanced, retracted, navigated, steered,bent, twisted, or contorted into various positions, shapes,orientations, and/or tight curvatures along tortuous pathways. Thefunctional characteristics of the elongate flexible torque instrumentsas described herein are particularly suited as extension tools fordeployment, placement, installation, maintenance, repair, or removaltype of functions, procedures, operations, or applications. Inparticular, the elongate flexible torque instruments may be well suitedas extension tools for performing various minimally invasive surgicalprocedures. e.g., deploying, placing, installing, or removing implants(e.g., prosthetic heart valves) inside a patient. For example, in aminimally invasive surgical procedure an implant may be delivered to atarget site in a patient through a percutaneous incision or natural bodyorifice using one or more elongate flexible torque instruments by way ofthe patient's vasculature or natural body pathways (such vasculature andnatural body pathways may be tortuous and less than 1 cm in diameter) tovarious organs (e.g., heart, stomach, bladder, uterus, etc.), or tissuestructures.

FIG. 1 illustrates an elongate flexible torque instrument in accordancewith one embodiment of the present invention, which may be used as anextension tool to deliver an implant in minimally invasive surgicalprocedures. As illustrated in FIG. 1, the elongate flexible torqueinstrument (100) includes an elongate body (102) that may be manuallypushed, advanced, steered, and/or rotated. The elongate body (102) mayhave an outer diameter in the range of about 1.5 French to about 30French—in the French catheter scale.

In some embodiments, the elongate body (102) may have an outer diameterin the range of about 20 French to about 30 French. In otherembodiments, the elongate body (102) may have an outer diameter in therange of about 10 French to about 20 French. In certain applications,the elongate body (102) may have an outer diameter of about 11 French orabout 12 French. In certain other applications, the elongate body (102)may have an outer diameter of about 9 French, about 8 French, about 7French, or about 6 French.

Handle (104) includes a control lever (106) that may operate one or morecontrol wires or pull wires to steer the distal portion of the elongatebody (102) as the elongate body is pushed or advanced through varioustortuous natural body pathways. The use of control wires or pull wiresto steer an elongate body has been previous described in various systems(e.g. a sheath member or a guide member of a manually steerablecatheter). Examples of such steerable systems are disclosed U.S. patentapplication Ser. No. 11/073,363, titled “Robotic Catheter System”, filedon Mar. 4, 2005; and U.S. patent application Ser. No. 11/481,433, titled“Robotic Catheter System and Methods”, filed on Jul. 3, 2006. Inaddition, a first control knob (108) and a second control knob (110) maybe manually operated to rotate elements or components of the elongatebody (102), such that rotation or torque applied at the first controlknob (108) and/or second control knob (110), either separately or inconcert, transmits rotation or torque from the proximal portion of theelongate body (102) to the distal portion of the elongate body (102).

The elongate body (102) and elements of the elongate body (102) may bedesigned and manufactured to be substantially stiff for torsionalapplications, such that there is minimum amount of torque deflection ortorque lag from one section (e.g., the proximal section) of the elongatebody or elements of the elongate body to another section (e.g., thedistal section) of the elongate body or elements of the elongate body.At the same time, the elongate body (102) or elements of the elongatebody (102) may also be designed and manufactured to be substantiallyflexible, so that the elongate body (102) may be steered, pivoted, ordeflected in various directions (e.g. up, down, pitch, yaw, etc.) aswell as bent or displaced into various positions, shapes, and/or tightcurvatures (e.g. a J-bend or a J-shaped bend). In addition, for certainapplications the elongate body (102) may be able to neutrally maintaincomplex shapes and tight curvatures. For example, no particular controlor force may be necessary to maintain the elongate body (102) in certaincomplex shapes or tight curvatures. As will be explained in furtherdetail, the elongate body (102) is comprised of segments that aresubstantially free to flex, bend, or pivot, such that that is nosubstantial resistance, inertia, or inherent shape memory properties toreturn or restore the elongate body (102) to a certain disposition,orientation, or shape.

In addition, the elongate body (102) may be operatively coupled to adelivery mechanism (112) to deliver an implant, such as a prostheticheart valve. The delivery mechanism (112) may be similar to thedeployment mechanism described in U.S. patent application Ser. No.11/364,715, titled “Methods And Devices For Delivery Of Prosthetic HeartValves And Other Prosthetics”, filed on Feb. 27, 2006; and U.S. patentapplication Ser. No. 11/364,724, titled “Methods And Devices ForDelivery Of Prosthetic Heart Valves And Other Prosthetics”, filed onFeb. 27, 2006, which are both incorporated herein by reference in theirentirety for all purposes. The elongate flexible torque instrument (100)along with the delivery mechanism (112) or similar delivery mechanisms(such as those described in the aforementioned patent applications) maybe used to deliver an implant, such as a prosthetic heart valve, whichmay be similar to those described in U.S. patent application Ser. No.11/066,124, titled “Prosthetic Heart Valves, Scaffolding Structures, AndSystems and Methods For Implantation of Same”, filed on Feb. 25, 2005;U.S. patent application Ser. No. 11/066,126, titled “Prosthetic HeartValves, Scaffolding Structures, And Systems and Methods For Implantationof Same”, filed on Feb. 25, 2005; and U.S. patent application Ser. No.11/067,330, titled “Prosthetic Heart Valves, Scaffolding Structures, AndSystems and Methods For Implantation of Same”, filed on Feb. 25, 2005;these patent applications are all incorporated herein by reference intheir entirety for all purposes.

FIG. 2A illustrates a portion or section of an elongate flexible torquemember (200) in accordance with one embodiment of the present invention,which may be one of the elements or components of the elongate body(102). The flexible torque member (200) may be fabricated from a tube orshaft made from any suitable material for the function, procedure,operation, or application for which the elongate flexible torqueinstrument may be used. As one of ordinary skill in the art having thebenefit of this disclosure will appreciate, the flexible torque member(200) may be fabricated from a rod or other elongate structure otherthan a tube or shaft. Accordingly, in some embodiments, the flexibletorque member (200) may include a lumen; while in some otherembodiments, the flexible torque member (200) may not include a lumen.For some embodiments, the elongate flexible torque instrument (100) maybe used for minimally invasive surgical procedures; as such the flexibletorque member (200) may be lubricated from a tube, shaft, rod, or otherelongate structure made of any biologically compatible material, e.g.stainless steel, Nitinol, other alloy or non-alloy material. Thefabrication process may include cutting the tube, shaft rod, or otherelongate structure into a plurality of segment members; such as firstsegment members (202 a) and second segment members (202 b), asillustrated in FIG. 2A.

In addition, various elements, features, or patterns may be cut into thesegment members, such that the finished flexible torque member (200)comprised of the segment members (202 a and 202 b) may be bothsubstantially flexible (e.g., flexible for steering movements ordeflection, such as up, down, pitch, yaw, etc.) and substantially stiffe.g. still for torsion, twist, and axial extension and compression,etc.). The plurality of segment members (202 a and 202 b) of theflexible torque member (200) may be physically linked. That is, asillustrated in this example, the segment members (202 a and 202 b) maynot be completely circumferentially cut into separate or individualpieces or segments; instead they may be physically linked together (forexample by a live link or living link (204 c), as illustrated by thematerial between the first link element (204 a) and second link element(204 b)) as a one piece unit. In other embodiments of the presentinvention, however, the segment members 202 a and 202 b) may becompletely circumferentially cut into separate or individual pieces orsegments. For those segments (202 a and 202 b) that are completelycircumferentially cut into separate or individual pieces, they may belinked or joined together by fitting or interlocking the separate orindividual segments (202 a and 202 b) together; similar to fitting orinterlocking pieces of puzzles together. The separate or individualsegments (202 a and 202 b) may be fitted together by way of theelements, features, or patterns that may have been cut into one or morepivotal link elements (not shown) of the segment members; similar to thephysical link elements but completely circumferentially cut.

FIG. 2A illustrates one embodiment of elements, features, or patternsthat may be cut into the segment members (202 a and 202 b). As may beappreciated, the geometries of the elements, features, or patterns maybe any shape and/or size that would facilitate the fitting orinterlocking the first and second segments (202 a and 202 b). Thelinking, fitting, or joining of the separate and individual first andsecond pieces or segments (202 a and 202 b) may be further facilitatedor made more secured by having the mating segments cut at various angles(α), as illustrated in FIG. 2B, so that the segments (202 a and 202 b)may be fitted or interlocked together more securely to reduce thechances for the segments (202 a and 202 b) to separate or the flexibletorque member (200) falling apart into pieces of segments (202 a and 202b).

In some embodiments, the segments may be cut at cut angle in rangebetween about 0 degree and about 90 degrees substantially about theperiphery of the features of the segments. In some particularembodiments, the segments may be cut at cut angle (α) in the rangebetween about 0 degree and about 30 degrees substantially about theperiphery of the features of the segments. In other embodiments, thesegments may be cut at cut angle (α) in the range between about 30degrees and about 45 degrees substantially about the periphery of thefeatures of the segments. In other particular embodiments, the segmentsmay be cut at cut angle (α) in the range between about 45 degrees andabout 60 degrees substantially about the periphery of the features ofthe segments. In further particular embodiments, the segments may be cutat cut angle (α) in the range between about 60 degrees and about 90degrees substantially about the periphery of the features of thesegments.

In some embodiments, the flexible torque member (200) may beencapsulated by a flexible membrane sheath to maintain the individualand separate pieces of segments together. The flexible torque member(200) may be made from a tube, shaft, rod, or other elongate structure,which may be cut by moving and turning the tube, shaft, rod, or otherelongate structure across a cutting tool to cut out the mating orinterlocking segments (202 a and 202 b) as well as the particularelements, features, or patterns that may help the segments (202 a and202 b) fit, mate, or interlock together. The cutting tool may bemanually controlled or computer controlled (e.g., a computer controlledlaser cutting tool) cutting system. In addition, the segments (202 a and202 b) as well as the particular elements, features, or patterns may becut at prescribed cut angles (a) as discussed to further provide securefitting or interlocking of the segments (202 a and 202 b) into one unitmaking up the flexible torque member (200). The cutting process mayremove a portion of the tube, shaft, rod, or other elongate structure soas to leave open spaces or gaps between first and second segments (202 aand 202 b). The width of these spaces or gaps may be substantially largeenough to allow adjacent segments (202 a and 202 b) to move, flex,pivot, or bend at various angles relative to each other. For example,the larger the space or gap between the first and second segments (202 aand 202 b), the greater the relative movement, flex, pivot, or bend maybe possible between adjacent segments (202 a and 202 b).

Still referring to FIG. 2A, first and second segments (202 a and 202 b)of the flexible torque member (200) include mating or interlockinggeometries of physical link elements (204 a and 204 b) and torque linkelements (206 a and 206 b). In this example, physical link elements (204a and 204 b) include live link or living link elements (204 c) in whichthe first and second segments (202 a and 202 b) are physically linkedtogether, such that the flexible torque member (200) is one continuouslyand physically linked member. In other embodiments, the physical linkelements (204 a and 204 b) may not include a live link or living linkelement, such that the flexible torque member (200) is not onecontinuously and physically linked member. Instead, the flexible torquemember (200) is comprised of fitted or interlocked separate andindividual segments (202 a and 202 b). The physical link elements (204 aand 204 b) allow the segments (202 a and 202 b) to flex, pivot, or bendrelative to each other, such that the flexible torque member (200) maybe steered in various directions or displacements, e.g., up, down,sideways, pitch, yaw, etc. In addition, the torque link elements (206 aand 206 b) includes torque fingers (206 c) that may provide torsional orrotational support or rigidity to the fitted, mated, contacted, orinterlocked segments (202 a and 202 b), such that the flexible torquemember (200) is flexible, e.g., up, down, sideways, pitch, yaw, etc.,but also torsionally stiff against rotation, twist, torque, etc.

FIG. 3 illustrates a portion or section of another flexible torquemember (300), in accordance with one embodiment of the presentinvention, including one embodiment of a physical link element (304) andone embodiment of torque link element (306). The flexibility of theflexible torque member (300) per unit length may be dependent upon theamount of flex, bend, or pivot between adjacent segments (302 a, 302 b,302 c, etc.) relative to each other. Since the amount that adjacentsegments (302 a, 302, 302 c, etc.) may be able to flex, bend, or pivotmay be determined by the space or gap between the segments, e.g., spaceor gap (410) illustrated in FIG. 4, the overall flexibility of thetorque member (300) per unit length may be determined or characterizedby the width of the space or gap (410) and the number of segments (302a, 302 b, 302 c, etc.) per unit length.

The physical link element (304) and torque link element (306) allow theflexible torque member (300) to be flexible while enabling the torquemember (300) the ability to transmit torque that is applied at one endof the torque member (300) to the other end of the torque member (300).As the flexible torque member (300) is rotated about its longitudinalaxis, as illustrated in FIG. 3 by the directions indicated by the arrow,the link elements (304 and 306) may transfer or transmit torsional forcelongitudinally along the length of the torque member (200), at whichpoint torque may be transferred or transmitted between the adjacentsegments (302 a, 302 b, 302 c, etc.) along the length of the flexibletorque member (300).

Looking more closely at FIG. 3, each physical link element (304) mayinclude to, strut elements (310) that may substantially surround aliving link element (308). A living link element (308) may be consideredas an element that provides a physical link between two membercomponents. In this example, the living link element (308) provides aphysical link between a first segment (302 a) and a second segment (302b). Similarly, the living link element (308S) also provides a physicallink between a second segment (302 b) and a third segment (302 c). Suchphysical linkages may continue on with many segments of a flexibletorque member. The strut elements (310) may have circular shapes or anysuitable geometrical shapes and may be configured to pivot within aspace, gap, or slot (312), which may have corresponding or mating shapesto the strut element (310) for receiving, matching, mating with thestrut elements (310), so that adjacent segment (e.g. 302 a and 302 b or302 b and 302 c) may flex, bend, pivot, etc. relative to one another.This combination of physical link elements or configuration may bereferred to as a splink link element since it is composed of thecombination of a spot link and a living link (as described in full inPCT Application Serial No. PCT/US2007/071535). Accordingly, in thisexample, a splink element or splink link element (304) may becollectively comprises a living link element (308), strut elements(310), the space, gap, or slot (312) between adjacent segment members(302 a, 302 b, 302 c, etc.) of a flexible torque member (300).

Still referring to FIG. 3, each segment (302 a, 302 b, 302 c, etc.) mayalso include torque link elements (306). A torque link element (306) mayinclude a male element (314) and a female element (16). As illustratedin FIG. 3, a male element (314) of one segment member (e.g., 302 a)mates with or fits into a female element (316) of an adjacent segmentmember (e.g., 302 b). The combination of mating or fitting of the maleelement (314) into the female element (316) in no way affects theflexing, bending, or pivoting or adjacent segments (e.g., betweensegment 302 a and 302 b, and between segment 302 b and segment 302 c,etc.) as allowed by the physical link element (304). The amount of flex,bend, or pivot between two adjacent segment members is defined orcharacterized by the amount of space or gap (e.g., space or gap (402))between the adjacent members as previously described. Each femaleelement 316 preferably receives the male element 314 in relative orsubstantial tight confines so as to allow movement in an axial directionbut not rotational, although minimal rotational movement may occur. Thedescribed torque link 306 may be referred collectively as torque fingerelement 306.

Referring again to FIG. 3, in some embodiments to increase theflexibility of the torque member (300), the physical link elements (304)or splink link elements (304) and the torque link elements (306) ortorque finger elements (306) may be oriented or disposed at about 90degrees with respect to each other. This may be done to enable theinterlocking or link elements 304 and 306 to hold or support thesegments (e.g., 302 a, 302 b, and 302 c) together such that the flex,bend, or pivot axes of the segments (302 a, 302 b, and 302 c) may bealternated between two perpendicular axes. For example, as illustratedin FIG. 3, the pivot axis (331) of adjacent segments (302 a and 302 b)is perpendicular to the pivot axis (332) of adjacent segments (302 b and302 c). The alternating pivot axes allow the torque member (300) toflex, bend, or pivot in variety of directions as well as definableranges about each axis. Each pair of interlocking or linking elements(304 and 306) transmits torque between the corresponding adjacentsegments (302 a, 302 b, and 302 c) when the torque member (300) isrotated along its longitudinal axis. In addition, the linking elements(304 and 306) may also provide column strength (e.g., compressive andtensile strength) to the torque member (300), such that the torquemember (300) may have necessary column strength or integrity to bepushed or advanced as well as pulled or retracted. For example, theflexible torque member (300) may be pushed or advanced as well as pulledor retracted along vasculatures or natural tortuous pathways inside apatient. Accordingly, the elongate body (102) of an elongate flexibletorque instrument (100), which may be constructed in pan by one or moretorque members, has the flexibility for flexing, bending, or pivotingand the stiffness to transfer or transmit twist, rotation, and torque aswell as the structural strength and integrity to be pushed or advancedand pulled or retracted along vasculatures or natural body pathwaysinside a patient.

Still referring to FIG. 3, in some embodiments, the physical linkelements (304) or splink link elements (304) of one segment (302 a, 302b, 302 c) may be oriented or disposed at about 180 degrees with respectto each other. Similarly, in some embodiments, the torque link elements(306) or torque finger elements (306) of one segment (302 a, 302 b, 302c) may be oriented or disposed at about 180 degrees with respect to eachother. While in some embodiments, the physical link elements (304) orsplink link elements (304) of adjacent segments (302 a, 302 b, 302 c)may be oriented or disposed at about 90 degrees with respect to eachother. Similarly, in some embodiments, the torque link elements (306) ortorque finger elements (306) of adjacent segments (302 a, 302 b, 302 c)may be oriented or disposed at about 90 degrees with respect to eachother.

The flexible torque member (300) may include optional guides firsteering cables (not shown) for steering the flexible torque member. Forexample, the torque member (300) may comprise four equally spaced guidesalong its inner surface for receiving four steering cables.Alternatively, the guides may also be on the outer surface of the torquemember.

One advantage of the splink link configuration described above is thefact that the torque shaft (300) requires minimal, if any, rotation ofthe shaft at a proximal end before torque is transmitted to the distalend. Before torque can be transmitted from one end of a torque member(300) to the other end, the rotational slack between each one of theadjacent sections or segments (302 a, 302 b, 302 c) of the shaft (300),if any, must be removed by rotating the shaft (300). The minimization orentire elimination of rotational slack allows an operator of the shaft(300) an increased level of control and precision in guiding the shaft(300) during delicate medical procedures.

FIG. 4 illustrates the interface of physical link element or splink linkelement and torque link element or torque finger element for oneexemplary embodiment of torque shaft (400) in a planar depiction. Theplanar depiction as illustrated in FIG. 4 shows the link patterns forthe link elements might be cut into the circumference of a tube, shaft,or any suitable elongate structure (for some application, a rod or othersolid elongate structure may be used) so as to form the torque member(400). As shown, the torque shaft (400) comprises a plurality ofsections or segments (402 a, 402 b, and 402 c) physically connectedtogether by living hinges (404). Adjacent segments (402 a, 402 b, and402 c) are connected to each other by a pair of living hinges (404)located approximately 180 degrees from each other about thecircumference of the torque shaft or torque member (400). Refer to FIG.2 and FIG. 3 for isometric or three-dimensional depiction of a torquemember for clarification of the spatial relationship between the linkelements. The segments (402 a, 402 b, 402 c) may be cut from a tube,shaft, or any other suitable elongate structure, in which thin portionsof the tube may be left connected between the segments (402 a, 402 b,402 c) to form the living hinges (404). The struts (408); space, gap, orslot (410); and the male/f male torque finger elements (412, 414) mayalso be similarly formed in the configuration as depicted in FIG. 4.Preferably, the stock tube, shaft, rod, or any suitable elongatestructure of which the torque member (400) is made from may be made of apliable material, metal, or plastic, e.g. NITINOL (or other NiTi alloy),stainless steel. MP35N alloy, or Polyetheretherketone (PEEK). Elgiloy,or any other pliable material that enables the living hinges to flex,bend, or pivot with the desired level of durability or resistance tofatigue or without plastic deformation.

In some embodiments, spaces, gaps, or slots (410) may be cut on bothsides of each living hinge element (404) to increase the length of thehinge element (404) to increase the amount movement that each hingeelement may be able to flex, bend, or pivot. The living hinge elements(404) allow adjacent segments (402 a, 402 b, 402 c) to flex, bend, orpivot relative to each. In some embodiments, wedge-shaped portions ofthe elongate structure may be cut away between adjacent segments toprovide the necessary spaces or gaps (410) such that adjacent segmentsmay be able to flex, bend, or pivot relative to each other. Adjacentpairs of living hinge elements (404) may be orientated at approximately90 degrees from each other. For example, as illustrated in FIG. 4, theliving hinge elements (404) between adjacent segments (402 a) and (402b) are orientated at about 90 degrees with respect to each other. The 90degree orientation between adjacent pairs of living hinge elements(404), when used on a torque shaft (400) having a relatively largenumber of segments (402 a, 402 b, 402 c, etc.), allows the torque shaft(400) to flex, bend, or pivot in a substantially smooth, fluid, orsubstantially unencumbered manner in various directions, e.g., X, Y, andZ directions.

Referring back to torque finger elements (314) of FIG. 3, each pair ofmale torque finger elements (314) extends from a segment (302) and isreceived in a pair of corresponding female torque elements (316) of anadjacent segment (302). To allow adjacent segments (302 a, 302 b, 302 c)to bend about the hinge elements (308), the female torque elements (316)are dimensioned so that the corresponding torque finger elements (314)may slide in and out of the female torque elements (316) to allow theadjacent segments (302 a, 302 b, 302 c) to flex, bend, and pivot aboutthe link elements (304). The torque finger elements (314), inconjunction with the living hinge arrangement (304) described above,transmit torque between adjacent segments (302 a, 302 b, 302 c) of theshaft (300) when the shaft is rotated about its longitudinal axis bypushing against the side walls of the corresponding female torqueelements (316).

FIG. 5 depicts a torque shaft with splink link and torque fingerinterlocking elements according to another embodiment. In thisembodiment, the torque shaft (500) includes the torque finger element(510) and corresponding female torque element (512) similar to thediscussion as described above, however, the splink link element (502) issubstantially rectangular-shaped with radiused contact surfaces asopposed to the substantially oval or teardrop-shaped physical linkelement as illustrated in FIG. 2, FIG. 3, and FIG. 4. As one of ordinaryskill in the art may appreciate, the geometrical construct of thesplink-link element may be varied without deviating from the inventivescope of the disclosed embodiments of the present invention. In thisembodiment, the living link (506) is manufactured so that there are twosubstantially curved male elements (508) surrounding the living link(506) on either side. The space, gap, or slot (S14) permits the adjacentsegments to pivot in relation to each other and allow the overallelongate structure or torque member (500) the ability to flex, bend, orpivot in a substantially fluid manner in various directions, e.g., X, Y,and Z directions.

FIG. 6A illustrates a side view of a torque shaft (600) with a wagonwheel link element (602) according to another embodiment of the presentinvention. FIG. 6B illustrates an isometric view of the same torqueshaft (600). Here, the torque shaft (600) may be laser cut in order toleave a “wagon-wheel” design that couples a plurality of segments (612a, 612 b, 612 c). As one of ordinary skill in the art having the benefitof this disclosure would appreciate, this embodiment provides similarbenefits to the torque shat construction previously discussed but uses aseries or plurality of living links to accomplish the task. As shown,each of the segments (612 a, 612 b, 612 c) has a pair of wagon wheellink elements (602) at substantially opposite portions of each segment(612). The adjacent segment (612) will have a pair of wagon wheel linkelements (602) at about 90 degrees offset so as to facilitate theflexible movement of adjacent segments (612 a, 612 b, 612 c).

Each wagon wheel link element (612) may include a hub portion (604) anda plurality of living link elements or “spoke” elements (606) extendingfrom the hub (604) to rim elements (610) of an adjacent segment (612).The degree of flexibility in this embodiment may be affected by eitherthe size of the spaces or gaps (608) and/or the length of the spokeelements (606). In order to compensate for the length needed during acompression or an operation cycle of the spokes (606). i.e. to allow thelengthening needed for turning of the pivot, the spoke elements (606)may have a slight elbow bend. In other words, the spoke elements may be“L-shaped”, which may resemble the shape of an elbow. The length, width,height, shape, orientation and number of the spokes (606) may betailored for a multitude of applications depending on its intended use.i.e., modifications can vary the stiffness of the torque member (600)and its axial/torsional strength. In another embodiment, the L-shapedspoke structure element of the splink link element may be implemented ona torque shaft (600) in combination with the torque finger elements, aspreviously described, to provide a flexible shaft with torquetransmission capability.

FIG. 7 illustrates one example of an interface or implementation offlexible torque members with an implant deployment apparatus inaccordance with one embodiment of the present invention. FIG. 7illustrates an example of an implant deployment device (702), which maybe substantially similar to the deployment mechanism described in U.S.patent application Ser. No. 11/364,715, titled “Methods And Devices ForDelivery Of Prosthetic Heart Valves And Other Prosthetics”, filed onFeb. 27, 2006; and U.S. patent application Ser. No. 11/364,724, titled“Methods And Devices For Delivery Of Prosthetic Heart Valves And OtherProsthetics”, filed on Feb. 27, 2006, which have been incorporated byreference in their entirely for all purposes. Flexible torque members(704 and 706) are operatively coupled to deployment device (702). Forexample, the flexible torque member 704 may be coupled to the wrappingpin hub (708) and flexible torque member 706 may be coupled to theslotted tube (710). The flexible torque members (704 and 706) may applytorque to the wrapping pin hub (708) and the slotted tube (710) tooperate the deployment device (702) for deploying and/or releasing animplant or a prosthetic device. A prosthetic device may be similar tothose described in U.S. patent application Ser. No. 11/066,124, titled“Prosthetic Heart Valves, Scaffolding Structures, And Systems andMethods For Implantation of Same”, filed on Feb. 25, 2005; U.S. patentapplication Ser. No. 11/066,126, titled “Prosthetic Heart Valves,Scaffolding Structures, And Systems and Methods For Implantation ofSame”, filed on Feb. 25, 2005; and U.S. patent application Ser. No.11/067,330, titled “Prosthetic Heart Valves, Scaffolding Structures, AndSystems and Methods For Implantation of Same”, filed on Feb. 25, 2005;which all have been incorporated by reference in their entirety for allpurposes. In some embodiments, the flexible torque members (704 and 706)may co-axially aligned and they may provide counter-acting torque,counter-rotating torque, or opposing torque to operate the wrapping pinhub (708) and the slotted tube (710) to deploy an implant or prostheticdevice contained in the deployment device (702).

FIGS. 8A-8C show a torque shaft (800) according to an embodiment of theinvention. The torque shaft (800) comprises a plurality of interlockingsections (812) cut into a steel tube. Some interlocking sections (812)may have different dimensions, e.g., one interlocking section (812) maylonger (length measured in an axial direction) than another interlockingsection (812), while other interlocking sections (812) may havesubstantially the same or similar dimensions. The sections (812) arelinked together by interlocking geometry of slots (815). Eachinterlocking slot (815) extends around the circumference of the tube andcomprises a plurality of interlocking features (820). The interlockingfeatures (820) of each slot (815) connect two adjacent sections (812) onopposite sides of the slot (815). FIG. 8B shows an expanded view of oneof the slots (815) and FIG. 8C shows an expanded perspective view of oneof the slots (815). In this embodiment, each slot comprises T-shapedinterlocking features (820). In broader terms, the male feature may bedescribed as having a base and an end, and the end has a width or heightthat is greater than the base. FIGS. 9A-9B show a torque shaft (900)according to another embodiment, in which each slot (915) comprisesteardrop-shaped interlocking features (920). The geometry of theinterlocking features can be any shape that interlocks.

In the preferred embodiment, the torque shaft may be fabricated by lasercutting the slots into a steel tube. This may be done by moving thesteel tube across a stationary laser under computer control to preciselycut the slots. Laser cutting is well known in the art for fabricating,e.g., stents.

Turning to FIGS. 8B and 9B, each of the slots (815, 915) has a width Wdefined by the width of the laser cut. The slot width W creates spacebetween adjacent sections that allow adjacent sections (812, 912) tomove slightly relative to each other. This movement allows adjacentsections (812, 912) to bend at a slight angle (e.g., 1-2 degrees)relative to each other. The larger the slot width W, the more adjacentsections (812, 912) can move, bend, or pivot relative to each other.

The flexibility of the shafts (800, 900) per unit length L depends onthe amount that adjacent sections (812, 912) can bend relative to eachother and the number of slots (815, 915) per unit length L. Since theamount that adjacent sections (812, 912) can flex, bend, or pivot isdetermined by the slot width W, the flexibility of the shafts (800, 900)per unit length is determined by the slot width W and the number ofslots (815, 915) per unit length L. The flexibility of the shafts (800,900) is approximately independent of the shape of the interconnectingfeatures of the slots.

The interlocking slots (815, 915) allow the shafts (800, 900) to beflexible while allowing the shafts (800, 900) to transmit torque appliedat one end of the shaft to the other end of the shaft. The torquetransferring capability of the shaft (800) is illustrated in FIG. 10,which shows an expanded view of two adjacent interlocking features (820)of a slot (815). As the shaft 800 is rotated about it longitudinal axisin the direction indicated by the arrow, the adjacent interlockingfeatures (820) of the slot (815) engage each other, at which pointtorque is transferred between the adjacent sections (812) of the slot(815).

FIG. 11 shows an interlocking slot (1115) according to anotherembodiment. In this embodiment, instead of a plurality of separateinterlocking slots along the shaft, a continuous spiral or helical slot(1115) runs along the length of the shaft (1100). Alternatively, two ormore helical slots may run along the length of the shaft. FIG. 11 alsoshows an example in which two contiguous interspaced helical slots(1125) and (1135) run along the length of the shaft (1110) next to eachother. The helical slots may have the same interlocking geometry ordifferent interlocking geometries.

FIGS. 12-13 show a spot-link torque shaft (1200) according to anotherembodiment of the invention. The torque shaft (1200) comprises aplurality of interlocking sections (1212). Each section (1212) comprisestwo male interlocking features (1215) on opposite sides of the section,and two female interlocking features (1217) on opposite sides of thesection and orientated about 90 degrees with respect to the maleinterlocking features (1215). The male interlocking features (1215) havesubstantially circular shapes and the female interlocking features(1217) have corresponding substantially inwardly curved shapes forreceiving the male interlocking features (1215) therein. The maleinterlocking features (1215) of each section (1212) fit into the femaleinterlocking features (1217) of an adjacent section (1212). This fitenables adjacent sections (1212) to pivot relative to each other aboutan axis. Each female interlocking feature (1217) curves around thecorresponding male interlocking feature (1215) may be more than 180degrees to prevent adjacent sections (1212) from being pulled apart.

To provide space for adjacent sections (1212) to pivot, portions of thetube forming the shaft are removed or cut away between the adjacentsections. In this embodiment, wedge-shaped portions of the tube are cutaway between adjacent sections to provide pivot spaces (1220). The pivotspaces (1220) between adjacent sections allow adjacent sections (1212)to pivot, e.g., 0-15 degrees, relative to each other.

The male interlocking features (1215) of adjacent sections (1212) areorientated at about 90 degrees from each other. This is done to enablethe interlocking features to hold the sections together. This is alsodone so that the pivot axes of the sections alternate (1212) between twoperpendicular axes. For example, in FIG. 13, the pivot axis of adjacentsections (1212 a) and (1212 b) is substantially perpendicular to thepivot axis of adjacent sections (1212 a) and (1212 c). The alternatingpivot axes allow the torque shaft (1200) to flex, bend, or pivot inrelatively unlimited directions about the axes.

The male interlocking features (1215) also enable the torque shaft(1200) to transmit torque from one end of the shaft to the other end ofthe shaft. Each pair of male interlocking features (1215) transmitstorque between the corresponding adjacent sections (1212) when the shaftis rotated along its longitudinal axis. In addition, the interlockingfeatures (1215) also provide column strength (compressive) and tensilestrength to the shaft (1200).

The torque shaft may include optional guides for steering cables. FIG.12 shows an example in which the torque shaft (1200) comprises foursubstantially equally spaced guides (1240) along its inner surface forreceiving tour steering cables. The guides may also be on the outersurface of the torque shaft.

The spot-link torque shaft has several advantages over the torque shaftwith interlocking slots. One advantage is that adjacent sections of thespot-link torque shaft are able to pivot or bend to a much greaterdegree than adjacent sections of the torque shaft with interlockingslots. As a result, the spot-link torque shaft requires far fewersections per unit length to flex or bend a given amount per unit lengththan the torque shaft with interlocking slots. This reduction in thenumber of sections reduces the amount of cutting required to fabricatethe spot-link torque shaft compared to the torque shaft withinterlocking slots.

Another advantage is that the spot-link torque shaft requires lessrotation of the shaft before torque is transmitted from one end of theshaft to the other end of the shaft. Before torque can be transmittedfrom one end of a torque shaft to the other end, the rotational slackbetween each one of the adjacent sections of the shaft must be removedby rotating the shaft. Because the spot-link torque shaft has fewersections than the torque shaft with interlocking slots, the spot-linktorque shaft has less rotational slack that needs to be removed beforetoque is transmitted from one end of the shaft to the other end.

FIG. 14 shows a torque shaft (1400) according to another embodiment. Thetorque shaft (1400) comprises a plurality of sections (1412 a, 1412 b,1412 c, etc.) connected together by living hinges (1415). Adjacentsections (1412 a, 1412 b, 1412 c, etc.) are connected to each other by apair of living hinges (1415) on opposite sides of the shaft (1400). Thesections (1412 a, 1412 b, 1412 c, etc.) are laser cut into a tube, inwhich thin portions of the tube are left connected between the sections(1412 a, 1412 b, 1412 c, etc.) to form the living hinges (1415).Preferably, the tube is made of a pliable metal, e.g., steel or Nitinol,or other pliable material that enables the living hinges to flex or bendwithout breaking. Slots (1417) are cut on both side of each living hinge(1415) to increase the length of the hinge (1415) and hence the amountthat each hinge can bend. The living hinges (1415) enable adjacentsections (1412) to flex, bend, or pivot relative to each other. Toprovide space for adjacent section (1412 a, 1412 b, 1412 c, etc.) tobend, portions of the tube are removed or cut away between adjacentsections. In this embodiment, wedge-shaped portions of the tube are cutaway between adjacent sections to provide space (1420) to flex.

Adjacent pairs of living hinges (1415) are orientated at about 90degrees from each other. For example, in FIG. 14, the pair of livinghinges (1415 a) between adjacent sections (1412 a and 1412 b) areorientated at about 90 degrees from the pair of living hinges (1415 b)between adjacent sections (1412 a and 1412 b). The 90 degree orientationbetween adjacent pairs of living hinges (1415) enable the torque shaft(1400) to flex or bend in many directions.

The torque shaft further comprises a pair of torque keys (1430) betweenadjacent sections (1412 a, 1412 b, 1412 c, etc.). Each pair of torquekeys (1430) extend from opposite sides of a section (1412 a, 1412 b,1412 c, etc.) and is received in a pair of slots (1435) in an adjacentsection (1412 a, 1412 b, 1412 c, etc). To allow adjacent sections (1412a, 1412 b, 1412 c, etc.) to bend about the hinges (1415), the slots(1435) are dimensioned so that the corresponding torque keys (1430) canslide in the slots (1435) to allow flexing, bending, or pivoting. Thetorque keys (1430) transmit torque between adjacent sections (1412 a,1412 b, 1412 c, etc.) of the shaft when the shaft is rotated about itslongitudinal axis by pushing against the side walls of the correspondingslots (1435). The torque keys (1430) may be contiguous with the sections(1412 a, 1412 b, 1412 c, etc.) or may be made of separate piecesattached to the sections (1412 a, 1412 b, 1412 c, etc.).

FIGS. 15-16 show two views of two torque shafts (1502 and 1504) with oneof the torque shafts (1504) disposed within the other torque shaft(1502). As explained above, a torque shaft has to be rotated by acertain amount at one end before torque may be transmitted to the otherend of the shaft. This amount of rotation is referred to as wind-up. Inthis example, the two torque shafts (1502 and 1504) may be operated toprovide opposing torque as indicated by the arrows in the FIGS. 15 and16. Since the two torque shafts (1502 and 1504) provide torque orrotation in oppose directions, each torque shaft may be pre-wound orpre-loaded to remove wind-up before use. In FIG. 15, the outer torqueshaft (1502) may be pre-wound in the counter clockwise direction and theinner torque shaft (1504) may be pre-wound in the clockwise direction asindicated by arrows. The torque shafts (1502 and 1504) may be pre-wounduntil the wind-up slack is removed from each of the two shafts (1502 and1504). When the torque shafts (1502 and 1504) are pre-wound, the outertorque shaft (1502) may tendency to unravel in the clockwise directionand the inner torque shaft (1504) may have a tendency to unravel in thecounter clockwise direction. To prevent the torque shafts (1502 and1504) from unraveling after they are pre-wound, an interlocking featuremay be placed between the two torque shafts.

FIG. 16 shows an example of a pin (1525) connected to the inner torqueshaft (1504) and received in a slot (1530) in the outer torque shaft(1502). The pin (1525) engages an end surface of slot (1530), whichprevents the two torque shafts (1502 and 15204) from unraveling. Theslot (1530) runs along part of the circumference of the outer shaft(1502) to allow the ends of the torque shafts (1502 and 1504) to berotated in opposing direction.

FIG. 17 shows an exploded and a perspective view of an example ofpull-pull torque drive (1700) according to an embodiment. The torquedrive (1700) comprises a slotted tube (1710), a cable drum hub (1720),and a sheave (1730). The drum hub (1720) is placed in the tube (1710)and rotates on the sheave (1730). The torque drive (1700) furthercomprises two cables (1735) running through coil pipes (1750) (only oneof the cables is shown in FIG. 17). The cables (1735) are threadedthrough channels (1740) in the sheave (1730) and wound around the drumhub (1720) in different directions. The end of each cable (1735) isattached to the drum hub (1720). FIG. 17 shows one of the cables (1735)wound around the hub (1720) in one direction. The other cable (notshown) is wound around the hub (1720) in the opposite direction.

The cables (1735) enable the cable drum hub (1720) to be rotated ineither direction with respect to the tube (1710) by pulling one of thecables (1735) axially. Pulling on one of the cables (1735) causes thatone of the cables (1735) to unwind around the hub (1720); thereby,rotating the hub (1720). This also causes the other cable (1735) to windaround the hub (1720) so that the hub (1720) can be rotated in the otherdirection by pulling the other cable (1735).

The pull-pull torque drive (1700) is useful for deploying a prostheticheart valve in a patient, which is described in more detail inapplication Ser. No. 11/066,126, filed on Sep. 15, 2005.

FIG. 18 shows a device (1800) for translating axial movement of theshaft (1825) into rotational movement of the shaft (1810). This may beused for transmitting torque to the distal end of the shaft by applyingaxial force to the proximal end of the shaft. The device (1800)comprises a cylindrical sleeve (1810) with a curved slot (1820) and apin (1815) connected to the shaft (1825) that slides in the slot (1820).When axial force is applied to the shaft (1825), the pin (1815)connected to the shaft travels along the curved slot (1820) of thesleeve (1810) causing the sleeve (1810) to rotate.

FIG. 19A illustrates an elongate flexible torque instrument (100) beingused to deliver an implant to a target site inside a patient inaccordance with one embodiment of the present invention. The process ofusing the elongate flexible torque instrument (100) to deliver anddeploy an implant is illustrated in process flowchart of FIG. 19B. Theprocess starts by inserting a distal portion of an elongate flexibletorque instrument into a patient, in step (1910). Typically, theinsertion is made through either a natural body opening or smallincision. As illustrated in FIG. 19A, a small incision is made near thefemoral vessel and the distal portion of the elongate flexible torqueinstrument (100) is advanced and navigated through the vasculature ofthe patient, in step (1920). In this example, the distal portion of theelongate flexible torque instrument (100) may be advanced and navigatedup to the inferior vena cava and into the right ventricle of thepatient's heart. The distal portion of the elongate flexible torqueinstrument (100) is further advanced through the septum and into theleft ventricle of the heart. From there, the distal portion of theelongate flexible torque instrument is navigated down, approximately 90degrees or more, and through the mitral valve and into the left atrium,as illustrated in FIG. 19C. Throughout this procedure the elongate body(102) may be required to be steered or navigated in various directionsand the torque members of the elongate body (102) may be flexed, bent,and/or pivoted in order to accommodate the movement of the elongate body(102) through various tortuous pathways of the vasculature. In addition,the elongate body (102) and the flexible torque members may be flexed,bent, and/or pivoted into various complex shapes and tight curvatures.As further illustrated in FIG. 19C, the distal portion of the elongateflexible torque instrument (100) is further navigated and advanced upthe aortic arch, which may require a significant tight turn,approximately 180 degrees, and the distal portion of the flexible torqueinstrument may be bent into a tight “J” shaped curvature. That is, thedistal portion of the elongate flexible instrument may be bent in a waythat is double-back forward itself type of configuration. As previouslydiscussed, the segment members of the flexible torque member areparticularly configured to allow such flexibility for the elongate bodyto form complex shapes and tight curvatures. As the distal portion ofthe elongate flexible torque instrument (100) is navigated intoposition, torque is applied at the proximal portion and transmitted tothe distal portion of the elongate flexible instrument to operate animplant deployment apparatus (112), in step (1930). In this example, thetransmitted torque operates an implant deployment apparatus (112) and animplant is deployed from the deployment apparatus (112) to a location ator near the aortic root, in step (1940). This procedure in delivering animplant may be known as the antegrade approach. Alternatively, aretrograde approach may also be used to deliver an implant, asillustrated in FIG. 19D. In this procedure, similar to the processdescribed in the flowchart of FIG. 19B. The process starts by insertinga distal portion of an elongate flexible torque instrument (100) into apatient. Typically, the insertion is made through either a natural bodyopening or small incision. In the example illustrated in FIG. 19A, asmall incision is made near the femoral vessel and the distal portion ofthe elongate flexible torque instrument (100) is advanced and navigatedthrough the vasculature of the patient. In the retrograde approach, thedistal portion of the elongate flexible torque instrument is navigatedfrom the femoral vessel through the vasculature to the aortic arch.Throughout this procedure the elongate body (102) may be required to besteer or navigated to various directions and the torque members of theelongate body (102) may be flexed, bent, and/or pivoted in order toaccommodate the movement of the elongate body (102) through varioustortuous pathways of the vasculature. The distal portion of the elongateflexible torque instrument (100) is navigated in to position at or nearthe aortic valve by way of the aortic arch, and then torque may beapplied at the proximal portion and transmitted to the distal portion ofthe elongate flexible instrument to operate an implant deploymentapparatus (112). In this example, the transmitted torque operates animplant deployment apparatus (112) and an implant is deployed from thedeployment apparatus (112) to a location at or near the aortic root.

While the specification describes particular embodiments of the presentinventive subject matter, those of ordinary skill in the art having thebenefit of this disclosure can devise variations of the subject matterwithout departing from the inventive concepts. In addition, the previousdescription is provided to enable a person of ordinary skill in the artto practice the various embodiments described herein. Variousmodifications to these embodiments will be readily apparent to those ofordinary skill in the art, and the generic principles defined herein maybe applied to other embodiments. Thus, the claims are not intended to belimited to the embodiments shown herein, but are to be accorded the fullscope consistent with the language of the claims, wherein reference toan element in the singular is not intended to mean “one and only one”unless specifically so stated, but rather “one or more.” All structuraland functional equivalents to the elements of the various embodimentsdescribed throughout this disclosure that are known or later come to beknown to those of ordinary skill in the art are expressly incorporatedherein by reference and are intended to be encompassed by the claims.Moreover, nothing disclosed herein is intended to be dedicated to thepublic regardless of whether such disclosure is explicitly recited inthe claims. No claim element is to be construed under the provisions of35 U.S.C. §112, sixth paragraph, unless the element is expressly recitedusing the phrase “means for” or, in the case of a method claim, theelement is recited using the phrase “step for.”

What is claimed is:
 1. An apparatus for transmission of torque,comprising: a plurality of segments coupled together in an elongateconfiguration, wherein each segment comprises: a first end comprising amale feature; and a second end comprising a female feature, the femalefeature having a shape corresponding to the male feature such that thefemale feature is configured to receive the male feature of the firstend of an adjacent segment.
 2. The apparatus of claim 1, wherein themale feature has at “T” like shape.
 3. The apparatus of claim 1, whereinthe male feature has a teardrop shape.
 4. The apparatus of claim 1,wherein the male feature is configured to interlock with the femalefeature.
 5. The apparatus of claim 1, wherein the male feature is afirst male feature and the female feature is a first female feature,each segment comprising: a second male feature on the first end, thesecond male feature being configured differently from the first malefeature; and a second female feature on the second end, the secondfemale feature being configured differently from the first femalefeature, the second female feature having a shape corresponding to thesecond male feature such that the second female feature is configured toreceive the second male feature of the first end of an adjacent rigidsegment.
 6. The apparatus of claim 1, further comprising a segmenthaving a second end that does not have a female feature.
 7. Theapparatus of claim 1, further comprising a segment having a first endthat does not have a male feature.
 8. The apparatus of claim 1, whereina first segment of the plurality of segments is pivotable with respectto an adjacent second segment of the plurality of segments.
 9. Theapparatus of claim 8, wherein the female feature of the second segmentis configured to rotate about the male feature of the first segment. 10.The apparatus of claim 9, wherein each segment comprises a pivot space,the pivot space is adjacent at least one of the male and femalefeatures, the female feature is a first female feature, the male featureis a first male feature, and the pivot space is a first pivot space,each segment further comprising: a second male feature located oppositethe first male feature and having the same configuration as the firstmale feature; a second female feature located opposite the first femalefeature and having the same configuration as the first female feature;and a second pivot space located opposite the first pivot space andhaving the same configuration as the first pivot space.
 11. Theapparatus of claim 8, wherein the first segment is coupled to the secondsegment by a hinge.
 12. The apparatus of claim 11, wherein the hinge isa living hinge, the male feature is configured to slide within thefemale feature, each segment further comprises a pivot space and atleast one of the male or female features is located in at least one ofthe pivot spaces of the segments, and the living hinge is a first livinghinge, the female feature is a first female feature, the male feature isa first male feature, and the pivot space is a first pivot space, eachsegment further comprising: a second living hinge located opposite thefirst living hinge and having a similar configuration to the firstliving hinge; a second male feature located opposite the first malefeature and having a similar configuration to the first male feature; asecond female feature located opposite the first female feature andhaving a similar configuration to the first female feature; and a secondpivot space located opposite the first pivot space.
 13. A medicalapparatus, comprising: a tubular member configured to interface with aprosthesis; a torque drive coupled with the tubular member andconfigured to rotate the tubular member, the torque drive beingconfigured to fit within the vasculature of a patient.
 14. The medicalapparatus of claim 13, wherein the tubular member is a torque shaft. 15.The medical apparatus of claim 14, further comprising a cable configuredto interface with the torque drive.
 16. The medical apparatus of claim15, wherein the torque drive is configured to translate axial motion ofthe cable into rotational motion of the torque shaft, wherein the torqueshaft comprises: a sheave; and a cable hub rotatably coupled to thesheave and fixably coupled with the torque shaft, the cable hubconfigured to receive the cable in a wrapped state.
 17. An elongateflexible torque instrument for deploying implants, comprising: anelongate body comprising a plurality of flexible torque members, whereineach torque member is comprised of segments, the segments beingconfigured to pivot with respect to an adjacent segment, and each torquemember is configured to transmit torque from a proximal portion to adistal portion of the torque member; a handle operatively coupled to theproximal end of each of the flexible torque members; wherein the handlecomprises a control lever configured to operate one or more controlwires to steer the elongate flexible body and a plurality of controlknobs configured to apply torque to the flexible torque members totransmit torque from proximal portions of the flexible torque members todistal portions of the flexible torque members; and an implantdeployment apparatus operatively coupled to the distal ends of theflexible torque members, wherein the implant deployment apparatus isconfigured to deploy an implant with torque transmitted to the flexibletorque members.
 18. The elongate flexible torque instrument of claim 17,wherein each segment is coupled to an adjacent segment by a linkelement.
 19. The elongate flexible torque instrument of claim 17,wherein the segments are pivoted about a link element.
 20. The elongateflexible torque instrument of claim 18, wherein the link element is aphysical link element, a pivotal link element, or a torque link element.21. The elongate flexible torque instrument of claim 17, wherein eachsegment is coupled to an adjacent segment by a combination of a physicallink element and a torque link element or a pivotal link element and atorque link element.
 22. The elongate flexible torque instrument ofclaim 21, wherein the physical link element is disposed about 90 degreesfrom the torque link element or the pivotal link element is disposedabout 90 degrees from the torque link element.
 23. The elongate flexibletorque instrument of claim 17, wherein the flexible torque members areconfigured to apply counter-acting torque, counter-rotating, or opposingtorque to the implant deployment apparatus to deploy an implant.
 24. Theelongate flexible torque instrument of claim 20, wherein the physicallink element comprises one or more struts and one or more spaces betweenthe one or more struts.
 25. The elongate flexible torque instrument ofclaim 20, wherein the torque link element comprises a male element and afemale element, and wherein the female element of one segment isconfigured to receive the male element of an adjacent segment.
 26. Theelongate flexible torque instrument of claim 17, wherein the segment arecut at an angle in the range between about (degree and about 90 degrees.27. The elongate flexible torque instrument of claim 17, wherein theflexible torque member includes a flexible membrane sheath to maintainthe segments together.
 28. A method for deploying an implant inside abody of a patient, comprising: inserting a distal portion of an elongateflexible torque instrument into a patient, the elongate flexible torqueinstrument comprising a plurality of flexible torque members, eachflexible torque member comprising a plurality of segments; advancing andnavigating the distal portion of the elongate flexible torque instrumentthrough natural pathways inside the patient to a target site; applyingtorque to a proximal portion of the elongate flexible torque instrument;and transmitting the applied torque from the proximal portion to thedistal portion of the elongate flexible torque instrument to operate animplant deployment apparatus, wherein the transmitted torque facilitatesdeployment of an implant from the implant deployment apparatus to thetarget site.
 29. The method for deploying an implant inside a body of apatient of claim 28, wherein counter-acting torque, counter-rotatingtorque, or opposing torque is applied to operate the implant deploymentapparatus.
 30. An apparatus for transmitting torque, comprising: anelongate body, the elongate body comprising a plurality of segments,each segment configured to pivot with respect to an adjacent segment andbeing further configured to have a pair of link elements, each linkelement having a hub and a plurality of physical link elements extendingfrom said hub and coupled with a rim of an adjacent segment.